The invention relates to surgical instruments useful in endoscopically guided procedures and in particular in laparoscopic surgery.
Laparoscopic surgery is conducted via the peritoneal cavity by percutaneous insertion of appropriate instruments through the abdominal wall. By manipulation of the instruments while viewing the surgical site through a laparoscope, surgery may be performed on the gallbladder, the kidneys, liver and large bowel, for instance.
Endoscopic surgery in general, and laparoscopic surgery in particular are recognized to have considerable advantages over open surgery because of the avoidance of large incisions and the discomfort, long and expensive hospital stay, and extended period of incapacity required by such incisions. Endoscopic procedures instead employ a few small penetrations of the body, which lessen the patient's discomfort, and reduce the time and expense of the hospital stay and the patient's period of incapacity.
Current methods of laparoscopy require filling the peritoneal cavity with carbon dioxide gas via an inflation device and maintaining inflation pressure. The gas expands the cavity by distending the abdomen, which provides room in which to maneuver the instruments to the selected surgical site. The surgeon uses a variety of instruments to conduct the surgical procedures. For instance, instruments used in isolating the gallbladder from its blood supply and ducts and then removing it from the body via one of the abdominal penetrations include J-form tissue-pulling hooks and retractors of various forms for electrosurgical and laser cutting and cauterizing, forceps, blunt-end dissectors, suction devices, and hollow trocars through which the various instruments are inserted. For the purpose of sealing blood flow in arteries and the like, a device for applying a sealing clip to the artery has been employed, for instance, the Endoclip available from U.S. Surgical, Inc.; typically it is inserted through one of the trocars after other instruments such as J-shaped retractors pull the artery into an exposed position. With the removal and introduction of each instrument through a trocar, carbon dioxide escapes from the peritoneum, and the supply must be replenished to maintain proper inflation, usually by manual methods. Additionally, electrosurgical and other cauterizing devices for laparoscopic or other types of surgery frequently stick to tissue due to the heat generated. One method of cooling has involved water cooling of the devices.
The number of required instruments and their repeated insertion and removal increases the time required for the procedure and its cost. It has been recognized that reduction in the time required for the procedure is highly desirable to enable more procedures to be performed at lower cost and to reduce physician fatigue.